The leftover topics from previous episodes

Medications - there is more than just ketamine in the drug box, who would have thought? 

Steroids

Often "forgotten" - low on protocol - EMS not likely to see "return on investment" - long time to onset

EMS part of the global patient care continuum - early admin decreases hospital admission

Time to drug in ED is slower (evaluation, orders, order check, preparation, administration) than out of hospital with 1:1 patient care ratio

Its worth the time, and patient care improvement to give in prehospital care

Useful in both adult and pediatric populations

Most common in our area - methylprednisolone - there are others, similar features / effects

What if we give it to the wrong patient? - Generally safe, cases may be multi etiology and may benefit even if there is a relative contraindication

Get it on board after acute treatments started (don't have to be "working") as early as possible

Magnesium 

Need to know your Medical Directors views  on where they want you to use, early or late - some variable thoughts on this

Generally safe, not going to get into trouble with BP with 2 grams - usually already hypertensive and tachycardic. 

Dextrose Concentrations

Have both D5 and D10 in the drug box

The 5% is for mixing drugs - not useful in treating acute hypoglycemia - supplied in 100ml bags - 5 grams of dextrose - suitable for mixing all med, some dont "like" normal saline

The 10% is for treatment of hypoglycemia - supplied in 250ml bag - 25 grams - not syrup, flows easy

50% is only supplied as the backup if 10% unavailable - 25 grams - syrup, does not flow easy

Glucometers

Use capillary blood, not calibrated for venous blood

know your glucometer read range <low >hi

We treat < 70 and / or symptomatic, if they normally "live" high, "low" for the patient could be higher than normal - treat symptoms

Determine patient normal range if able

Vitals 

Required. If it wasn't documented it wasn't done

Must trend, one set is a single snap shot time

Is glucose and capnography now standard? 

Manual blood pressures still best practice to validate the machine -  defiantly 

Monitor collects and trends - use to your advantage - import to ePCR, there are no questions on what's true - delete obviously erroneous info

Worth the time to set the NIBP interval down on critical patients

Always use the event log, even if narrative is complete - nobody gets "credit" if not in event log - narrative is not reportable, event log is reportable